Our members have rights and responsibilities. Our Member Services representatives serve as their advocates. Below are the rights and responsibilities of members.
Members have the right to:
Be treated with respect and with due consideration for their dignity and privacy.
Expect that we will treat their records, including medical and personal information and communications, confidentially.
Request and receive a copy of their medical records at no cost to the member and request that the records be amended or corrected.
Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation as specified in federal regulations.
Take part in decisions regarding their health care
Receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand.
Engage in candid discussions of appropriate or medically necessary treatment options for their conditions regardless of cost or benefit coverage.
Receive the appropriate services that are not denied or reduced solely because of medical condition.
Refuse health care (to the extent of the law) and understand the consequences.
Decide ahead of time the care they want if they become sick, injured or seriously ill by making a living will.
Be able to make decisions about their children’s health care if members are younger than age 18 and married, pregnant or have children.
Grievances, appeals and fair hearings
Pursue resolution of grievances and appeals about the health plan or care provided.
Freely exercise filing a grievance or an appeal without adversely affecting the way they are treated.
Continue to receive benefits pending the outcome of an appeal or a fair hearing under certain circumstances.
Receive the necessary information to be a BlueCross BlueShield member in a manner and format they can understand easily.
Receive a current member handbook and a provider directory.
Receive a copy of the member handbook and/or provider directory by request by calling Member Services at 1-866-231-0847 (TTY 711).
Receive assistance from the health plan in understanding the requirements and benefits of the plan.
Receive notice of any significant changes in the benefit package at least 30 days before the intended effective date of the change.
Make recommendations about our rights and responsibilities policies.
Know how we pay our providers.
Choose their PCPs from our network of providers.
Choose any health plan network specialist after getting a referral from their PCPs, if appropriate.
Be referred to health care providers for ongoing treatment of chronic disabilities.
Have access to their PCPs or backups 24 hours a day, 365 days a year for urgent or emergency care.
Get care right away from any hospital when their symptoms meet the definition of an emergency medical condition.
Get post-stabilization services following an emergency medical condition in certain circumstances.
Be free from discrimination and receive covered services without regard to race, color, creed, gender, religion, age, national origin ancestry, marital status, sexual preference, health status, income status, program membership, or physical or behavioral disability, except where medically indicated.
Members have the responsibility to:
Respect their health care providers
Treat their doctors, their doctors’ staff, and other health plan employees with respect and dignity
Not be disruptive in the doctor's office
Make and keep appointments and be on time
Call if they need to cancel an appointment or change the appointment time or call if they will be late
Respect the rights and property of all providers
Cooperate with the people providing health care
Tell their providers about their symptoms and problems and ask questions
Supply information providers need in order to provide care
Understand the specific health problems and participate in developing mutually agreed-upon treatment goals as much as they are able
Discuss problems they may have with following their providers' directions
Follow plans and instructions for the care they have agreed to with their practitioners
Consider the outcome of refusing treatment recommended by a provider
Discuss grievances, concerns and opinions in an appropriate and courteous way
Help their providers obtain medical records from their previous providers and help their providers complete new medical records as necessary
Secure referrals from their PCPs when specifically required before going to another health care provider unless they have a medical emergency
Know the correct way to take medications
Go to the emergency room when they have an emergency
Notify their PCPs as soon as possible after they receive emergency services
Tell their doctor who they want to receive their health information
Follow health plan policies outlined in the member handbook
Provide us with proper identification during enrollment
Carry their Anthem and Medicaid ID cards at all times and report any lost or stolen cards
Contact us if information on their ID cards is wrong or if there are changes to their name, address or marital status
Call us and change their PCP before seeing the new PCP
Tell us about any doctors they are currently seeing
Notify us if a member or family member who is enrolled in the health plan has died